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Know Your CBDs

By
Catherine Ashe, DVM
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46
CBD “supplements” for dogs come in many forms; the most common are liquids that are meant to be administered from a syringe or dropper, and liquid that has been mixed into edible treats or chews.

It’s everywhere: CBD, the “miracle” drug. Each week, I probably have several clients inform me – their veterinarian – that they are giving this supplement to their dogs. Their intention and hope is that the supplement will cure their dogs of a vast array of disorders, including allergies, seizures, immune-mediated syndromes, and cancer. Despite the fact that the treatment was their idea, and that they found the product on their own – in a health food store, online, or made in a kitchen by someone they know – they often ask me, “What is it, exactly? Do you think it works?”

If you decide to administer products that contain CBD to your dog, you need to be aware that they are untested and unapproved, and that your veterinarian may not have any experience or reliable information about any adverse reactions your dog experiences.

The History of CBD Research and Discoveries

It’s hard to believe that a complex chemical signaling system that helps our bodies maintain homeostasis by sending protein messages between cells was only recently discovered – in the late 1980s, in fact – by researchers who were trying to learn why and how marijuana makes humans high. Weird, but true: The first piece of what has been named the endocannabinoid system (ECS) was discovered by researchers who were trying to figure out what part of the brain is affected by marijuana.

Actually, the word “marijuana” is a pejorative name, popularized in the 1920s, for dried parts of Cannabis plants. Marijuana became the commonly accepted name for the dried flowers and leaves of Cannabis plants,  just as tobacco has become the commonly accepted name of the dried leaves of Nicotiana plants. 

In 1964, scientists first isolated the chemical compound in Cannabis that causes psychoactive effects in humans and other mammals; it was named Delta-9 tetrahydrocannabinol (THC). This chemical, in both a version that is derived from Cannabis plants and synthetic, chemically reconstructed versions, have been widely studied because of their behavioral effects on humans.

In the late 1980s, still trying to figure out what is responsible for the psychoactive effect that THC has on mammals, researchers found, in the brain of rats, unequivocal evidence for the presence of a specific receptor that “takes up” (responds to) THC. Receptors are chemical structures that receive and transduce signals, and cause some form of cellular/tissue response. The receptor that responded to THC was named CB1 (cannabinoid 1).

The CB1 receptor was subsequently identified in other mammalian brains, including those of humans.

Once the receptor was identified in mammal brains, researchers began to realize that mammal brains contained a lot of these receptors. In fact, once they knew what to look for, they found CB1 to be present in a similar density to receptors for other critical neurotransmitters, including glutamate, GABA, and dopamine. Why on earth do mammals have such a wealth of receptors for chemicals found in Cannabis?

A second cannabinoid receptor, CB2, was discovered in 1993, in a surprising place: a rat spleen. In a very short time, researchers looking specifically for these receptors in humans found a wealth of them – and in a variety of places in the body! CB1 receptors are most plentiful in the brain and central nervous system; CB2 receptors are found widely in the immune system and peripheral organs. Both receptors are also found in the gut.

Of course, the presence of chemical receptors in the body suggests there are endogenous chemicals (chemicals produced in the body – “endo” means inside) that are interacting with those receptors. Molecules that bind to receptors are called ligands, and soon enough, scientists discovered the endogenous ligands for those receptors.

Research into the function of this signaling/responding system – what has been named the endocannabinoid system (ECS) – is current and ongoing. In recent years, scientists have learned that the ECS plays a role in regulating a number and variety of physiological functions, including appetite, temperature, motor control, fertility, mood, and pain, to name a few.  

When activated by a loss of homeostasis, the body produces  and releases endocannabinoid ligands (cannabinoids made inside the dog’s body), which bring the affected system back into normal balance. Once they are finished with their job, there are also enzymes that help break down the endocannabinoids.

According to “Review of the neurological benefits of phytocannabinoids,” published in Surgical Neurology International in 2018, “Manipulations of endocannabinoid degradative enzymes, CB1 and CB2 receptors, and their endogenous ligands have shown promise in modulating numerous processes associated with neurodegenerative diseases, cancer, epilepsy, and traumatic brain injury.”

We’re getting to CBD . . .

The ingestion of derivatives of Cannabis plants affect humans and other mammals (like our dogs) because they contain ligands that just happen to interact with CB1 and CB2 receptors in our bodies. These chemicals may be referred to as exogenous cannabinoids (“exo” means outside; exogenous means they were made outside the body) or phytocannabinoids (“phyto” means “of a plant”).

Here is a fact that might surprise you: There are more than 100 different cannabinoids found in Cannabis plants. Again, because of its significant psychoactive effects on mammals, THC is the best-known. But the first cannabinoid compound that was identified in Cannabis was dubbed cannabidiol (CBD). Though it is quickly rising in the Cannabis-sourced cannabinoid popularity contest, when it was first identified (in 1940!), it was more or less dismissed by the chemists who mapped its chemical structure as having “no marihuana activity.” 

They were correct: CBD does not have psychoactive effects. But its growing population of fans in the medical community think it may have benefits in relieving pain, nausea, anxiety, depression, and seizure activity, among many other potential benefits in animals that have cannabinoid receptors in their bodies (humans and dogs among them).

Let’s talk about what is known about CBD, what is yet unproven, and why I can’t make any recommendations to my clients, pro or con, about CBD products.

Popularity Boom

The rapidly growing population of CBD fans in the medical community think it may relieve pain, nausea, anxiety, depression, and seizure activity. You may hear even more claims for its purported benefits, but these are the ones that, so far, have the most scientific evidence to support them.

Those claims sound amazing! So why isn’t the veterinary community jumping on the use of CBD for pets? Well, it’s complicated.

For the most part, the claims of CBD’s health benefits for pets are being made on the strength of pharmaceutical company research that has used synthetic analogues of cannabinoids; widespread anecdotal evidence; and very small, very recent studies of CBD on dogs.

The ability to study CBD in research labs was highly compromised until very recently. For many years, pharmaceutical companies that wanted to investigate cannabinoids have had to use synthetic versions. That’s because, in the United States, Cannabis was officially outlawed for any use (medical included) with the passage of the Controlled Substances Act of 1970.

However, in 2018, plants classified as “hemp” – Cannabis species with less than 0.3% dry weight of the psychoactive cannabinoid substance, Delta-9 tetrahydrocannabinol (THC) – were descheduled as controlled substances by the 2018 Farm Bill. This removed significant research barriers for both academic and commercial research into CBD, as well as legal barriers for growing and harvesting these plants, then refining and selling products that contain CBD to the public. In response, the market has been flooded with CBD-containing products for humans and – of particular interest to readers of this journal – dogs!

Supplemental Problems

While this might be a good thing, it does introduce new problems. First, these products are not subject to any regulatory oversight. Why? Because they have been classified as “supplements,” not “drugs.”

Any drug that makes therapeutic claims (prevents, cures, or manages disease) must be approved by the U.S. Food and Drug Administration (FDA). This ensures that the drug is safe and effective.

However, this process does not apply to products that are considered to be supplements, which is how most CBD products are currently treated. By virtue of the Dietary Supplement Health and Education Act of 1994 (DSHEA), supplements may not be labeled or marketed for the prevention, diagnosis, treatment, mitigation, or cure of disease.

Instead, supplement manufacturers can make only “structure or function” claims: They may only “describe the role of a nutrient or dietary ingredient intended to affect the structure or function in humans” (or pets) or “characterize the documented mechanism by which a nutrient or dietary ingredient acts to maintain such structure or function.”

Does that sound like gibberish? A 2018 article entitled “How to Market CBD Products in a Sea of Uncertainty,” published in Cannabis Business Executive (it’s an actual thing) clarified the difference and offered these tips to companies that aspire to produce and sell CBD-containing companies:

What are the Dos for a CBD vendor?

  • Do utilize cosmetic claims (“beautifies,” “improves”).
  • Do refer to emotions (“decreases irritability”).
  • Do use words like “wellness,” “supports,” “maintains.”
  • Do refer to general body parts including systems.
  • Do use qualifiers like “mild” and “occasional” to differentiate a temporary condition from the symptoms of the disease.
  • Do use FDA disclaimer but only with structure/function claims: “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent disease.”

What are the Don’ts for a CBD vendor?

  • Don’t use words like “treat,” “cures,” “repairs,” “acute,” “disease,” “chronic.”
  • Don’t mention diseases like cancer, fibromyalgia, osteoarthritis.
  • Don’t refer to symptoms like fever, coughing, sneezing.
  • Don’t use disease claims.
  • Don’t recommend any product to augment another drug.
  • Don’t recommend a product as a substitution for another drug.

Further, since there is no legally required pre-sale testing or oversight of the production or labeling of supplements, it’s quite possible that there is no resemblance between what a label says and what is actually in the product. No tests are required to determine the purity or safety of any of these CBD supplements – or to confirm the reliability of any testing that a manufacturer may claim to have conducted.

It’s the wild, wild west out there! A study published in the Journal of the American Medical Association in 2015 found that CBD/hemp products were significantly mislabeled and often contained much more or less CBD than reported. Other concerns include purity and adulteration with substances possibly toxic to dogs, such as xylitol.

Current Studies

Those of us who like our supplements to be served along with a healthy dose of scientific data supporting their use are holding off on trying out these products for a bit longer. Other than a handful of small-scale studies looking at the use of CBD oil in dogs, there is no data on veterinary usage. Most available information is individual case studies and/or anecdotal.

So far, there have been only three studies that have evaluated the use of CBD in dogs.

It’s big business: This is just one of more than 40 booths at the 2019 Global Pet Expo pet products trade show for a company that is marketing CBD supplements for dogs.

 

The earliest was published in January 2018 in Frontiers in Veterinary Medicine and evaluated the oral pharmacokinetics, safety, and efficacy of CBD oil. The results showed that CBD in the concentrations used appeared safe, well-tolerated, and to decrease pain associated with osteoarthritis. Serum alkaline phosphatase, a liver value (SAP or ALP) was noted to increase, but this is not uncommon with many drugs, including phenobarbital and prednisone. This is called liver induction and can occur with drugs that rely heavily on liver metabolism. The significance of this finding is not known.

A second study, published in September 2018, evaluated adverse effects when CBD oil was given to a group of 30 healthy research dogs. Several different formulations were used, and despite the differences, all the dogs in the study developed diarrhea. Some also developed elevations in SAP, as in the first study. Overall, the CBD was considered to be well-tolerated but more research is needed on the significance of the associated diarrhea, as well as the liver enzyme increases.

A random sample: CBD supplements for dogs come in oils, tinctures, chews, cookies, and more.

 

Very recently (June 2019), a study was released evaluating CBD oil used in combination with antiseizure medications in dogs with intractable epilepsy. One group received CBD-infused oil, and the other received a placebo. The seizure frequency did decrease in the CBD oil group, but the results need further study. As in previous studies, SAP was increased in many of the patients.

The American Veterinary Medical Association is actively encouraging well-controlled studies into the uses of cannabinoids at this time. It is also working with the FDA to encourage the development of veterinary-specific products. State veterinary associates are making strides, as well, in addressing the sudden abundance of products and claims.

Veterinary Constraints

Veterinarians and “Legal” CBD Products

There is not a single medication containing CBD that is approved by the United States Food & Drug Administration (FDA) for animals.

In 1994, the FDA introduced the Animal Medicinal Drug Use Clarification Act (AMDUCA), which allows veterinarians to use medications in patients “off-label”  – using the drug in a manner that is not in accordance with the approved label directions. Using a drug in this manner can include using a drug in a dose, frequency, or route of administration that is not on the label or in a species for which it is not labeled. So, for example, we may use drugs that are FDA-approved for humans on our animal patients. This must be done within the bounds of a valid veterinary-client-patient relationship.

There is only one Cannabis-derived medication containing CBD that is FDA-approved, and so could conceivably be prescribed or recommended legally “off-label” by a veterinarian for a dog. That drug is Epidiolex, and it is used for the management of seizures in humans with specific types of abnormalities. But the estimated annual cost of this medication is $32,500, making it prohibitively expensive for the majority of dog owners.

One more thing you must know: By law, veterinarians are currently prohibited in every state from dispensing or administering cannabis or cannabis products to an animal patient. It doesn’t matter if your dog suffers a chronic, painful condition or seizures. It doesn’t matter if the product is a supplement (rather than a drug), and you were able to buy it in a pet supply store.

Except for veterinarians licensed in California, Colorado, and Oregon, we can’t even legally discuss CBD products with our clients. Why are veterinarians in those states allowed to talk about it?

In late 2018, California became the first state to pass veterinary-specific legislation that amended the state’s Business and Professions code to allow veterinarians to discuss Cannabis and its derivatives. It also requires that the California Veterinary Medical Board develop guidelines for these discussions by the year 2020. Like every other state, however, California’s code also specifically “prohibits a licensed veterinarian from dispensing or administering Cannabis or Cannabis products to an animal patient.”

The Colorado Veterinary Medical Association’s position statement on what it calls “marijuana and marijuana-derived products” says that the state “recognizes the interest of companion animal lovers and veterinarians regarding the potential benefits of marijuana therapies for a variety of animal medical conditions. Similar to human medicine, there is extremely limited data on the medical benefits and side effects of marijuana products in companion animals.”

Further, the Colorado position statement clarifies that veterinarians licensed in that state “have an obligation to provide companion animal owners with complete education in regard to the potential risks and benefits of marijuana products in animals. . . . Any discussion regarding a specific marijuana product as part of a companion animal’s therapeutic regimen should be consistent with a valid veterinarian-client-patient (VCP) relationship.”

Veterinarians and “Legal” CBD Products

There is not a single medication containing CBD that is approved by the United States Food & Drug Administration (FDA) for animals.

In 1994, the FDA introduced the Animal Medicinal Drug Use Clarification Act (AMDUCA), which allows veterinarians to use medications in patients “off-label”  – using the drug in a manner that is not in accordance with the approved label directions. Using a drug in this manner can include using a drug in a dose, frequency, or route of administration that is not on the label or in a species for which it is not labeled. So, for example, we may use drugs that are FDA-approved for humans on our animal patients. This must be done within the bounds of a valid veterinary-client-patient relationship.

There is only one Cannabis-derived medication containing CBD that is FDA-approved, and so could conceivably be prescribed or recommended legally “off-label” by a veterinarian for a dog. That drug is Epidiolex, and it is used for the management of seizures in humans with specific types of abnormalities. But the estimated annual cost of this medication is $32,500, making it prohibitively expensive for the majority of dog owners.

Oregon’s Veterinary Medical Examining Board emailed its members a memo in August 2016 stating, “Veterinarians may discuss veterinary use of Cannabis with clients, and are advised to inform clients about published data on toxicity in animals, as well as lack of scientific data on benefits. Please be aware that a client’s written consent is needed for any unorthodox treatment.”

The states’ legislation and veterinary medical board rulings will likely change quickly, as the landscape of Cannabis use is rapidly evolving. But at the moment, with many veterinarians fearing that they could face legal repercussions for violating their state regulations, few pet owners have much recourse for discussion about CBD with veterinarians.

You Are On Your Own

I’ll repeat this: If you decide to administer products that contain CBD to your dog, you need to be aware that they are untested and unapproved, and that your veterinarian may not have any experience or reliable information about any adverse reactions your dog experiences.

If you are taking your dog to a veterinarian for treatment, tests, or advice and your dog is receiving CBD products of any kind, make sure that the veterinarian is aware of this; ideally, she can alert you to the dangers of any potential adverse drug interactions between the CBD and any prescription drugs (or other supplements) that you may be giving your dog.

Your veterinarian also should be alerted to help you be the lookout for side effects – or perhaps, one would hope, to recognize any signs of improvement in your dog’s health and/or comfort.

Osteosarcoma: Causes, Diagnosis, and Treatment

By
Barbara Dobbins
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12
Don’t wait to investigate if your dog develops a chronic or intermittent limp, especially in large-breed dog, and especially if it’s in a front leg. Too often, this is a sign of osteosarcoma.

Osteosarcoma (OSA) has been found in every vertebrate class and has even been identified in dinosaur fossils, but it appears to be more prevalent in dogs than in any other species. While there are different types of bone cancer, more than 85% of the bone malignancies diagnosed in dogs are OSA.

When compared to other types of cancers found in dogs, the incidence rate of primary OSA is low, with an estimated 10,000 dogs newly diagnosed each year. Its survival rate varies considerably depending on which treatments are used, but, unfortunately, none of the current treatments have high rates of success. Many promising new treatments are in the works, however.

The most common clinical signs associated with OSA are pain, swelling, and lameness in the affected leg. Lameness occurs due to pain, inflammation, microfractures, or pathologic fractures (fractures caused by normal movements due to bone deterioration caused by disease). If swelling is present, it is likely due to the spread of the tumor into the surrounding soft tissues.

Where OSA Is Found

OSA can develop in any bone, but the most common form – the appendicular (limb) form – occurs in the long bones of the legs and accounts for 75 to 85% of cases. Within this subtype, the rate of occurrence in the forelimbs is twice that of the hindlimbs, often located at the top of the humerus (shoulder) or the bottom of the radius (wrist). On the hindlimbs, knee and ankle areas are common locations. These locations are at the ends of bones, at or near the growth plates where cell turnover is high during growth.

While the majority of the remaining cases occur in the axial skeleton (the bones of the head and trunk), there have been cases of OSA documented in extraskeletal sites including the skin and subcutaneous tissues, as well as the lungs, liver, mammary glands, and other organs and glands.
[post-sticky note-id=’365174′] Osteosarcoma affects mostly middle-aged and older dogs; 80% of cases occur in dogs over 7 years of age, with 50% of cases occurring in dogs over 9 years old. Younger dogs are not immune; approximately 6 to 8% of OSA cases develop in dogs who are just 1 to 2 years of age. OSA of the rib bones also tends to occur in more often in younger dogs with a median age of 4.5 to 5.4 years.

Cause

As with most canine cancers, the cause is unknown. There has been no gender predisposition documented. There does appear to be a genetic component as OSA predominates in long-limbed breeds. Large and giant breeds have an increased risk of OSA because of their size and weight. Small dogs can develop OSA as well, but it is far less common.

Notably, the forelimbs support about 60% of total body weight of the dog and are the most common limbs to develop OSA. It is theorized that in addition to body size, the fast growth rate to create the longer bones in large breeds might contribute directly to OSA risk. Rapid bone growth results in increased bone remodeling and increased cell turnover; high cell division and turnover occurs naturally at and near the growth plates, which are also the most common sites for tumor development.

A dog’s risk also appears to increase if he has had surgery for a fracture repair or an orthopedic implant. These conditions spur the proliferation of bone-forming cells. OSA also has been associated with fractures in which no internal repair was performed. Other possible causes include chronic bone and bone marrow infections, microscopic injury in the weight-bearing bones of young growing dogs, ionizing radiation, phenotypical variations in interleukin-6 (a protein produced by various cells), abnormalities in the p53 tumor-suppressor gene, viral infections, and chemical carcinogens.

Hormonal risk factors are being actively explored in an effort to determine if there is an increased risk for OSA based on the age of spay or neuter (gonadectomy). In May 2019 Makielski et al. authored a comparative review of OSA risk factors and included this commentary on trending current hormonal studies (Veterinary Sciences Vet Sci 2019, 6, 48):

 

“Similarly, associations between reproductive status and development of osteosarcoma have been inconsistent. Although several reports suggest that spayed and/or neutered dogs have higher incidence of certain cancers, including osteosarcoma, the relationship between reproductive status and cancer risk may be confounded by other variables, such as the documented tendency toward increased adiposity and body condition in gonadectomized dogs. Increased load combined with delayed physeal (growth plate) closure, a result of gonadectomy prior to skeletal maturity, could theoretically contribute to increased osteosarcoma risk in dogs.”

Diagnosis and Staging

Clinical presentation of canine OSA typically appears as lameness of the affected limb, with or without visible swelling or mass at the affected area.

[post-sticky note-id=’365169′] Diagnostic exams usually include a physical exam, an orthopedic and neurological examination (to eliminate other causes of lameness), and radiographs (x-rays). Radiographs may allow for a presumptive diagnosis as OSA frequently has a characteristic appearance in the bones: patterns of bone destruction, abnormal bone growth, and sometimes fractures.

If a tentative diagnosis of OSA has been made, additional screening tests are recommended to ensure your dog is otherwise healthy; these may include a blood panel, thoracic radiographs, and CT scan. Ultrasounds are often performed but early metastasis to the abdomen is very rare. A bone aspirate for cytology with alkaline phosphate stain is common and recommended. This may occur as part of the screening process or obtained during surgery.

OSA is extremely aggressive and typically metastatic. While only 10 to 15% of dogs will have measurable metastasis, it is believed that up to 95% of dogs have undetectable metastasis at the time of diagnosis. Because of this high metastatic risk, additional assessment is recommended. Most metastatic spread appears in the lungs so thoracic radiographs are warranted.  Survey radiographs also may be recommended due to an 8% risk of metastasis to other bones. Metastasis may also be seen in lymph nodes (5%) and internal organs.

If available, PET scans or nuclear scintigraphy (sometimes referred to as a “bone scan” or “Gamma scan”) are even more sensitive diagnostic tools that can identify diseases not visible with other imaging methods. It can be useful for the detection of metastasis in dogs as it can distinguish any region of osteoblastic activity, including osteoarthritis and infection.

While there are several published histologic grading systems for OSA, there is no universally accepted system, making the predictive value of routine grading of OSA questionable.

Staging of OSA utilizes the TNM (Tumor-Node-Metastasis) System, the standard system used for most tumor staging in veterinary medicine. Three stages of OSA can be differentiated:

Stage I indicates a low-grade tumor (G1) with no evidence of metastasis (M0)

Stage II indicates a high-grade tumor (G2) without metastasis.

Stages I and II are further divided into two subgroups: Group A indicates that the tumor has stayed within the bone (T1). Group B indicates that the tumor has spread beyond the bone into other nearby structures (T2). Most dogs are diagnosed with Stage IIB OSA.

Stage III is a tumor with metastatic disease (M1).

Treatment

The primary considerations for treatment of OSA should include an understanding of how far the disease has metastasized, how to treat the bone tumor itself, and how to curb, delay, or prevent recurrence or spread of the disease. The disease develops deep in the bone and destroys it from the inside; as a result, it can be extremely painful and treating that pain can be a challenge. Above all, any approach should ensure that the dog maintains excellent quality of life.

  • Surgical

Wide-margin surgery, by either limb amputation or limb-sparing surgery, is indicated as the standard initial treatment of canine appendicular OSA. While biopsies are typically recommended prior to surgery for most types of cancer, it is not a necessity with OSA when there are other diagnostic indicators.

  • Amputation
Two “tripod dogs” meet at the dog park: What are the odds? Amputation of a limb affected by OSA is the quickest way to relieve the dog’s pain and most of the destructive processes of the disease.

Removal of the limb extracts the local cancer immediately and is the quickest and most effective way of alleviating pain and most of the destructive processes of OSA. It also removes the risk of a painful pathological fracture, which often occurs as the disease progresses.

Because pain inhibits quality of life, amputation is considered a quality of life choice. The majority of dogs recover quickly and resume a normal life on three legs. Amputation completely removes the primary tumor, is not a complicated surgery and requires less anesthesia time, offers a decreased risk of postoperative complications, and is a less expensive procedure than limb-sparing surgery (discussed next).

  • Limb-Sparing Surgery

Limb sparing can be preferable to amputation for dogs who suffer from existing severe orthopedic or neurological diseases; candidates for limb-sparing surgery should be in otherwise good health with a primary tumor confined to the bone. This surgical procedure replaces the diseased bone with a metal implant or bone graft or combination of the two to reconstruct a functional limb.

[post-sticky note-id=’365172′]

Limb sparing surgery temporarily improves the overall condition of the leg, but eventually the cancer will progress and the bone will deteriorate. Limb function is preserved in more than 80% of dogs. However, complications are fairly common with this procedure. Infections occur in 30 to 50% of cases, implant failure in 20 to 40%, and 15 to 25% of dogs will experience tumor recurrence. Subsequent chemotherapy and radiation treatments also may be recommended.

  • Stereotactic Radiosurgery (aka SRS, Stereotactic Radiotherapy/SRT, Cyberknife)

Stereotactic radiosurgery is an alternative to amputation or limb-sparing surgery; it also may be used as an adjunct therapy following amputation. It is a nonsurgical procedure (but does require anesthesia) that delivers radiation directly to the tumor site. Radiation acts by making cancer cells unable to reproduce.

SRS precisely transmits several beams of radiation aimed from various angles to deliver a high dose of radiation to a designated tumor target. The delivery system is effective and efficient and therefore reduces the chance of damage to surrounding normal structures and tissues. Potential downsides to SRS include fracture from radiation-induced bone degradation and possible tumor regrowth. Early reports suggest that the outcomes of SRS followed by chemotherapy may be comparable to those achieved with amputation and chemotherapy.

  • Chemotherapy

The best outcomes for dogs with OSA to date have been for those undergoing amputation followed by chemotherapy. Since tumor removal does not address metastasis, systemic treatment via chemotherapy can be vital to a treatment plan. Several studies have reported prolonged survival rates using cytostatic drug protocols, with carboplatin, cisplatin, and doxorubicin the most commonly used.

Side effects from chemotherapy tend to occur infrequently; when they do, they are usually predictable, minor, and manageable. A dog undergoing chemotherapy can expect to have excellent quality of life.

  • Immunotherapy

For the latest in immunotherapy treatment for OSA, see WDJ March 2019 “A New Bone Cancer Vaccine for Dogs.”

Other Treatments

  • Palliative Radiation

The primary goal of palliative radiation is to maintain good quality of life for cancer patients, whether human or canine. It is used to control clinical signs and pain associated with tumors that either cannot be treated by other techniques or where more aggressive treatments have been declined.

As an added benefit, palliative radiation may slow the rate of progression and reduce the size of the tumor, thereby further contributing to the well-being of the patient. Dogs with OSA initially undergo two to five treatment sessions (requiring anesthetic) and are typically administered in lower dosages than that used for stereotactic radiosurgery.

Most dogs will achieve some degree of pain relief within the first one to two weeks following treatment, with the potential for it to be effective for a couple of months. When pain returns, radiation can be re-administered for if deemed appropriate.

  • Bisphosonate Drugs

Bisphosphonates, such as pamidronate and zoledronate, are easily administered through intravenous (IV) infusions and are aimed at preventing or slowing bone destruction and reducing pain and risk of fracture, therefore prolonging the dog’s life. This treatment is relatively inexpensive, has a wide safety margin, and can even be used on dogs with renal or liver insufficiency.

These drugs are usually used in combination with chemotherapy and/or radiation therapy but may be used alone. Additionally, bisphononates appear to have potential cancer-suppression effects by impeding proliferation and inducing apoptosis (programmed cell death); as a result, they have become a targeted area for new research.

  • Pain Management

Again, because OSA can be extremely painful, recognition and alleviation of pain is essential for maintaining quality of life. Dogs with OSA may experience pain due to a number of causes: the cancer itself, a treatment modality, or a concurrent disease such as osteoarthritis. To preemptively and adequately control pain, more than one medication is often required.

Nonsteroidal anti-inflammatory drugs (NSAIDS) are typically a mainstay for controlling pain – but aren’t the best choice for the type of pain associated with OSA. However, they may be used to address other forms of pain being experienced concurrently. Gabapentin, amitriptyline, duloxetine, and amantadine are better suited to alleviating OSA-related pain.

Weight control can help by relieving the extra pressure on joints; supplements also may be recommended to help support the unaffected joints. Physical therapy and massage can be beneficial, especially for the compensating joints and muscles. Acupuncture, having been shown to increase endorphins (which inhibit pain perception), also can provide an avenue for pain management.

Palliative Care

Palliative care is an approach that prioritizes measures to relieve symptoms (without curative intent) and improve comfort. It is a valid and respected choice for care; only owners can decide what is best their dogs. Palliative care also can be provided to dogs who are at the end stage of their disease.

Prognosis

The heartbreaking reality is that the vast majority of dogs affected by OSA will succumb to the disease or be released through euthanasia due to disease progression. Dogs who do not receive any form of cancer-specific treatment are usually euthanized within one to two months of diagnosis due to uncontrolled pain.

Those treated with surgery alone (amputation) have an average survival period of about four to five months; almost all die within a year and only 2% live past two years.

Dogs receiving surgery and chemotherapy have average survival times of approximately 10 months, with up to 28% alive after two years.

The median survival time for dogs receiving radiation therapy and chemotherapy is about seven months.

In general, dogs between 7 and 10 years old tend to have longer survival times than younger and older dogs.

The prognosis is very poor for dogs with Stage III OSA; the average survival time is 2.5 months. Dogs less than 7 years old with a large tumor located at the top of the humerus also have a very poor prognosis. Dogs with axial OSA have an average survival time of four to five months as complete surgery is usually prohibitive due to tumor location and likely recurrence. If regional lymph node metastasis has been found, survival time is only about 1.5 months.

This Is A Tough One

With the increasing amount of research being conducted on OSA, there is hope for new therapies, increased survival times, and improved outcomes. But for many, it won’t be soon enough. Bear, my friend Keri’s dog, succumbed to OSA while I was writing this. He lived 16 months after diagnosis with palliative care and lots of love. He is very much missed.

Fear Free Veterinary Care

By
Sassafras Lowrey
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26
Too frequently, this is what our dogs look like while waiting for or during a veterinary examination. Can you imagine being terrified or full of dread during every doctor visit? (Maybe some of you are!) Fortunately for our dogs, there is a movement afoot to change how our pets are handled and treated in veterinary hospitals.

Does your dog know when you are approaching the veterinary clinic? Sadly, many dogs are nervous, anxious, or just uncomfortable at the vet’s office.

Thankfully there is a movement of veterinary professionals who are working hard to create positive, low-stress experiences for dogs entering veterinary hospitals, reducing stress for dogs (and owners!). And the organization that is providing formal training to veterinarians and their staff members also teaches dog owners how to help their dogs feel more comfortable at the vet.

Visionary Veterinary Visits

Fear Free is the brainchild of Marty Becker, DVM, whose veterinary practice is the North Idaho Animal Hospital in Sandpoint, Idaho.  Dr. Becker is better known for his weekly nationally syndicated newspaper feature “Pet Connection” and his 17-year stint as the resident veterinary contributor on “Good Morning America.” He is also the author of some 25 books on pets and pet health.

“The idea for Fear Free and the slogan ‘Taking the pet out of petrified,’ came out of a lecture by a boarded veterinary behaviorist, Dr. Karen Overall,” says Dr. Becker. “Previously, I, like the vast majority of my colleagues, thought of pet’s distress at the veterinary office as unavoidable collateral damage. Through her lecture, I knew that we – all of us who deal with animals including veterinarians, veterinary nurses, trainers, groomers, boarding personnel – were causing repeat, severe, irreversible psychological damage to the animals we care for. Nobody gets into a career of working with animals to make life worse for them.”

Dr. Becker began envisioning an organization that could educate pet professionals of all kinds about how to recognize the signs of fear, anxiety, and stress, and how to handle pets in ways that at least reduce, and at best, eliminate these emotions and the negative behavioral fallout that often results from handling that does not consider or prioritize the animal’s experience.

Fear Free’s founder, Dr. Marty Becker, says “Fear Free is where state-of-the-art veterinary medicine meets state-of-the-heart veterinary medicine.”

“Once we realized the damage we were doing to pets, and the potential physical and emotional benefit we left unrealized, hundreds of top veterinary professionals and others involved in animal care committed to bringing a science-based, compassionate approach to pet care,” Dr. Becker says. He collaborated with veterinarians, veterinary behaviorists, and force-free trainers to create a curriculum, and offered the first Fear Free certification course in 2016.

Today, Fear Free provides education and certification to veterinary professionals in methodologies developed by board-certified veterinary behaviorists, anesthesiologists, pain experts, and more. According to the organization, more than 48,000 veterinary and pet professionals (including groomers, trainers, and more) have been certified in Fear Free dog-handling techniques.

Ultimately, the Fear Free approach to handling dogs in any situation is beneficial to the dog population as a whole, but its most potent gifts may lie in improving our pets’ veterinary visit experience.

“Fear Free veterinary visits make taking the dog to the hospital fun for the dog and fun for the dog’s guardian, for the veterinarian and for veterinary personnel, too,” says Kenneth Martin, DVM, DACVB, a co-owner of Veterinary Behavior Consultations, in Austin, Texas.

Dr. Martin explains that the Fear Free practices “take the fear, anxiety, and/or stress out of waiting to be seen by the veterinarian. Dogs are provided with non-slip surfaces, calming pheromones, aromatherapy, and soothing music. Greetings include a considerate approach to interactions with the dog, who is touched and handled in ways that reduce stress. Treats, toys, and various distraction techniques are used to keep the dog comfortable and make the visit enjoyable.”

Unless you know in advance that your vet hospital supplies its patients with comfy mats for the waiting and exam rooms, bring one from home!

This is not business as usual in a vet clinic! Every interaction between the dog, owner, and clinic staff is intentional, and “the dog’s emotional response to the veterinary visit is noted to make each and every veterinary visit a more enjoyable experience, from the trip to the hospital until arriving back home,” Dr. Martin says.

Fear Free Certification

Fear Free offers courses for veterinary professionals  and staff on how to improve animal hospital encounters for their patients. Fear Free has considered every aspect of the patients’ veterinary hospital experience and has suggestions for changes that result in a drastic drop in the patients’ stress and discomfort.

Veterinary staff members who take the courses learn how to recognize the signs of stress and fear in their patients, understand how a patient’s perception affects its behavior in the veterinary hospital setting, assess their own hospitals for stress-provoking infrastructure and practices, and employ dozens of new tactics to improve the vet-hospital experience for their clients’ pets. There are currently eight modules in the course, with an examination at the end of each module. A veterinary provider must pass each exam with a score of 80% or more in order to continue. Upon successful completion of all the modules, a Fear Free certificate is awarded. The certification is valid for one year; continuing education units and examinations must be completed annually for the practitioner’s certification to remain current.

Hospital Certification

A veterinarian working in a group practice can become certified individually, but if there are other staff members with an interest in Fear Free precepts, they might want to pursue a Fear Free practice certification, described on FearFreePets.com:

 

“Practice Certification takes Fear Free implementation to the next level – from an individual to a joint effort that requires the entire practice team to work together to safeguard the emotional wellbeing of their patients, clients, and team members.”

 

In order for a practice to become certified, more than 25% of the staff must be Fear Free Certified with active memberships; this must include 100% of the practice’s leadership and/or management team and 50% + 1 of the practice’s full-time veterinarians.

Once a practice has achieved this and completed an online self-assessment of the standards, Fear Free will send a Fear Free Practice Certification Veterinarian to conduct an on-site visit and evaluation of the practice. The results will be submitted to Fear Free for review and final determination of pass or fail.

The basic Fear Free certification course costs $279 for an individual; the price per person for the certification decreases when the number of people working in the same veterinary practice who also seek certification increases.

Maintaining an active membership requires an annual fee of $99 per person and completion of four continuing education units each year from Fear Free’s large library of educational offerings. All of this adds up to a significant investment of money, time, and interest in providing a stress- and fear-free veterinary experience to the practice’s patients.

Dr. Patricia Slanga, a Fear Free certified veterinarian, recently opened this beautiful practice she designed and built according to Fear Free precepts: Noah’s Glen Animal Hospital in Morgantown, Pennsylvania.

Fear Free Veterinary Visits Are Different

In many ways a Fear Free approach to veterinary care is about prioritizing the needs of your dog above all else and ensuring that he is comfortable in any veterinary setting. “We have made huge advancements that have allowed us to help dogs live longer and healthier lives by looking after their physical well-being,” says Jonathan Bloom, DVM, a Fear Free certified practitioner at the Willowdale Animal Hospital in Toronto, Ontario. “Now it’s time for us to help dogs live happier lives, by looking after their emotional well-being.”
[post-sticky note-id=’365150′] Employing a Fear Free approach to veterinary care gives our dogs agency at the vet office, instead of being forced to comply. Dr. Bloom explains how Fear Free protocols put the needs of the pet first – and how this requires veterinary practitioners to shift their approach to ensure the dog is comfortable.

“If pets don’t like being up on exam room tables, we examine them on the floor. If they don’t like liver treats, then we offer them chicken treats. If they feel more secure being near their owners, then we do their entire exam, vaccine, blood sample collection, etc., beside their owners,” he says.

Fear Free practitioners generally book longer appointments times and require their technicians to use Fear Free restraint and handling methods so their patients are not rushed or intimidated into compliance during examination procedures. Because more time is taken with the animals, the practitioner may charge more for visits than vets who spend just a few minutes with the patient, leaving the collection of vital signs and biological samples (blood, urine, feces) to the technicians.

When an entire practice is Fear Free-certified, the client should notice even more departures from conventional veterinary clinics. Waiting rooms are arranged in a manner that gives dog and cat clients plenty of room so they feel safe and not overstimulated, and provisions are on hand to make any wait comfortable for the patients, with soft beds or mats and non-slip paths that facilitate a smooth flow of patient traffic. Species-specific appeasing pheromone diffusers and/or aromatherapeutic diffusers will likely be in use in waiting and exam rooms.

When the visit is complete, a technician may invite you and your dog to relax and enjoy some treats in the exam room while your bill is being prepared; you can make a payment, receive medications and instructions, and make a follow up appointment (if needed) in the same room, so when all of this business is complete, you and your dog can make a smooth exit to your car, instead of having to stand in line back in the waiting room to do these things.

Even the disinfectants in a Fear Free certified practice are likely to be different from those used in veterinary hospitals that don’t adhere to Fear Free protocols.

“When you embrace Fear Free certification, you begin to realize that our patients can suffer sensory overload during their veterinary visit. Overwhelming sights, sounds, and smells need to be eliminated when you make a commitment to Fear Free,” says Julie Reck, DVM, owner of the Veterinary Medical Center of Fort Mill (South Carolina).

Dr. Reck switched all the cleaning products in her hospital to an accelerated hydrogen peroxide-based disinfectant that kills pathogens but does not leave a lingering chemical smell, and pheromone diffusers are used throughout the facility. The disinfectant is not only less overwhelming for the patients, she says, it’s safer for the clients and staff.

Dr. Reck is also a huge proponent of Fear Free practice certification; not only is her practice Fear Free certified, she joined the Fear Free Executive Council and is on the organization’s speaker’s bureau.

Emotional Health Complements Physical Health

It’s scary to think about how one negative experience at a vet clinic, or even just a couple uncomfortable ones, can adversely affect how your dog regards vet visits for the rest of his life. I witnessed this with my youngest dog, who needed major surgery before her second birthday. She went from a puppy who loved going to the vet to a dog who became wary of vet visits after several stressful and painful  diagnostic visits and consultations before bilateral TPLO surgery.

Dr. Martin says that this type of negative experience isn’t necessary. “In the past, the veterinarian and dog owner alike have justified the stress of the veterinary visit and/or procedure as being in the best interest of the dog – but the dog doesn’t know that!” says Dr. Martin. In contrast, he describes the Fear Free protocols for a vet visit as “a feel-good sensory experience, incorporating pleasant sights, sounds, smells, taste, and touch.”

But Fear Free veterinary visits aren’t just about making dog feel better emotionally; they also can have measurable impacts on your dog’s physiological health – and your veterinarian’s ability to accurately diagnose or monitor your dog’s health.

“Stress negatively influences physical parameters such as heart rate, respiratory rate, and temperature,” says Dr. Martin. “In the stressed individual, these parameters, routinely checked with most veterinary visits, are not an accurate representation of the dog’s overall health. And stress suppresses the immune response.”

Canine Constipation

By
Catherine Ashe, DVM
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5
You need to investigate if your dog seems to be straining and/or staying in the “poop posture” for a long time. Constipation becomes more serious over time, so start home treatment ASAP, and don’t wait too long to seek veterinary attention if your dog hasn’t produced stool within a few days.

Constipation seems like it should be a straightforward medical problem, but this is far from the case! Constipation occurs when there is difficulty or inability to empty the bowels. Stools may be extremely firm. A dog will strain and remain in the “poop posture” for quite some time before producing a bowel movement. In some cases, only mucus will pass.
There are many possible causes, including:

  • Eating indigestible material or very dry material such as pork bones
  • Arthritis pain that makes “assuming the posture” difficult
  • Dehydration
  • Malformations of the pelvic canal (congenital or acquired)
  • Drugs such as opioids
  • Behavioral
  • Neurological disease leading to weakness

The normal frequency of bowel movements (BMs) can vary hugely among individual dogs. In general, one to two BMs per day is the minimum, with some dogs going much more frequently. Because the large intestine is such a stretchy organ, a dog can go several days between bowel movements without significant issue. If a dog goes an exceptionally long time without defecating (a week or longer), though, obstipation – a severe form of constipation – can result. This is when the colon is packed with extremely hard, dry feces and passing them is not possible without assistance.

Are you sure it’s constipation?

Diarrhea may be mistaken for constipation, especially if a dog usually is unsupervised at potty time. Persistent diarrhea causes inflammation of the intestines and leads to discomfort and straining, even when there is no stool in the colon. Monitoring your dog’s bathroom habits is important and should be done at least daily.

One easy thing to consider any time you are worried about constipation is a fecalith. Sometimes, especially in small dogs with very long hair, a firm fecal ball can become stuck to the hair around the anus and obstruct the outside. In dogs with dark hair, this is easy to miss! This is a quick and simple fix with a pair of scissors and gloves. Anytime you see your dog straining at home, a quick look at the perianal area can identify the cause in some cases.

Symptoms of constipation you might see at home include posturing without producing any feces, straining but producing only small amounts of stool or no stool at all, bright red blood on the outside of the stool (due to inflammation and colon trauma), and in severe cases, decreased appetite and vomiting.

If you suspect constipation, check in with your veterinarian. The symptoms of straining and frequent trips outside might indicate constipation or a urinary problem, which also can be life-threatening.

Preliminary Home Treatment

Home remedies that can help with constipation are numerous and varied in their success. Do not administer over-the-counter laxatives. Instead, you can add plain canned pumpkin to your dog’s food, anywhere from one to two tablespoons per meal. This adds fiber and bulk while increasing colon motility.

If you think dehydration is playing a role, increase your dog’s water intake by adding some canned food to his meals (mix in a little more water for greater effect), dropping a few ice cubes to his water to encourage drinking, and using a recirculating water fountain. A gentle increase in exercise can also improve bowel motility, so take your canine companion for a walk! If this doesn’t accelerate your pet’s gastrointestinal (GI) motility, it’s time to visit a veterinarian.

See Your Vet!

During the examination, your veterinarian will start with a complete history. Questions will include the diet your dog is currently eating including any treats, any medications and supplements that you give, normal frequency of BMs, and what changes you’ve noticed.

Then your veterinarian will assess every system from head to toe. Once the basic system exam is completed, your veterinarian should focus on abdominal palpation and a rectal exam. While it’s not pleasant for your dog (or for you to see!), this is very important. This digital exam can detect many abnormalities and possible causes. It allows the veterinarian to palpate the urethra where it runs underneath the colon, the sublumbar lymph nodes, the prostate (in male dogs), the anal glands, and the mucosal surface of the rectum and colon. The pelvic canal can also be felt.

As with most diseases in dogs, common causes can be ruled in or out based on the signalment (the age and breed).

Very young puppies (less than 6 weeks) with constipation should be evaluated for a congenital abnormality of the rectum and/or colon. Some breeds that may be predisposed include any with short “screw tails” like Pugs and English Bulldogs. When the tail is exceptionally short, there can be underlying spinal abnormalities that cause nerve dysfunction.

Another abnormality is atresia ani, when the anus doesn’t form, and there is nowhere for feces to exit. Puppies who are being bottle raised may also deal with constipation from the puppy milk replacer.

Other Possible Causes

In older puppies who are chewing and eating food, checking for ingestion of foreign material that might lead to fecal impaction is important. This can include sand, rocks, and bone.

Trauma to young dogs that free roam is also a possibility. It isn’t uncommon for a stray pup to be adopted from a shelter situation only to discover old, healed injuries. Pelvic fractures can be one of these types of injuries, leading to a narrow pelvic inlet, and difficulty passing feces.

As dogs age the causes of constipation often become more systemic in nature and may include organ disease such as kidney failure and diabetes mellitus leading to dehydration, neurological disease like  degenerative myelopathy, and arthritis pain can all contribute. This is why a head-to-tail-tip examination is so important!

Reproductive status can also play a role. Intact male dogs develop two particular problems as they age: benign prostatic hypertrophy (BPH) and perineal hernia. Both can lead to difficulty defecating (and urinating).

In the case of BPH, the influence of testosterone causes the prostate to enlarge symmetrically. The condition is not cancerous and non-painful, but if the prostate becomes large enough, it can make defecating and urinating difficult. Treatment is removal of the testosterone source via neutering.

Perineal hernia is also caused by the influence of testosterone. The muscles surrounding the rectum (the perineal muscles) become weak with age and can separate. Abdominal organs, particularly the bladder and colon, can herniate through and lead to difficulty with urinating and defecating. The symptoms are straining and a soft, reducible bulge on one or both sides of the rectum. Again, neutering and surgical repair are the treatments of choice.

Treatment

General constipation treatment depends on the underlying cause. If the constipation is fairly recent in onset, in a young dog, the initial diagnostic testing may just include a physical exam, history, and x-rays to rule out a foreign object. Therapy can then be directed at relieving the discomfort.

Several ways to do this exist including administration of enemas with warm water (sometimes including soap or lubrication), increasing fiber in the diet by adding canned pumpkin or switching to a high fiber diet, increasing water intake, and administration of medications such as lactulose, a stool softener.

If the constipation has been ongoing for a while, and the dog is older, other tests will likely be recommended. These include bloodwork to evaluate for systemic diseases as mentioned above, and possibly an abdominal ultrasound to look for a cause of obstruction.

In severe cases, it might be necessary to manually disimpact. This should be done under heavy sedation and/or general anesthesia. It is painful and invasive, and a dog must be fully relaxed for the best outcome. Prior to disimpaction, the veterinarian may treat with intravenous (IV) fluids to rehydrate first, as well as administer an enema to allow the feces to soften as much as possible. Lactulose may also be added prior to surgery to help with removing the feces. Bloodwork will be reviewed for any electrolyte abnormalities that need correction.

It is not common in dogs, but a condition called megacolon can develop. This describes a syndrome in which there is persistent dilation and slow to no motility. It can happen as a result of long-term, unresolved constipation causing stretching and damage of the nerves. Unfortunately, this can be difficult to resolve. In some cases, the megacolon is reversible if there is a definite underlying cause (such as a pelvic fracture) that can be surgically repaired. The earlier this is done, the better the chances for a good outcome.

Kids and Dogs

By
Pat Miller, CBCC-KA, CPDT-KA
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16
Dog Bites
Is the child about to be bitten? Or does the dog adore the kid? We don’t know! This is a stock photo! The dog may be trying to avoid the child, or just turning her head . . . However, we can say that this isn’t something that you should allow your child to do with any but the most rock-solid, kid-loving dog – and if this is the only type of dog your child has experience with, you will have to make sure he doesn’t have the opportunity to try it with dogs whose kid-tolerance is unknown.

These days, it seems that every time someone posts a picture on social media of a child with a dog it is immediately followed by a spate of posts expressing horror at the anticipated savage attack likely to follow.

Granted, some of those photos do, indeed, show dogs displaying body language signals that suggest a significant amount of discomfort at the proximity of the child, and real potential for injury. But many of them also, in my opinion, depict normal, healthy interactions between dogs and young humans.

Dogs and kids have been happy buddies for centuries. While dog bites to children are nothing new (I was bitten by a stray puppy at age five, in 1956) we seem to be much more reactive to them as a culture than we used to be. When did we become a society so phobic about any dog/kid interaction? And, perhaps more important, how do we help people recognize and create safe, healthy relationships between dogs and children?

It’s Not Cute, It’s Abuse

There is a truly horrendous video on YouTube of parents encouraging their very young child to abuse their Rottweiler. The child runs over to the dog, who is lying on the floor, climbs on his back, hugs him violently – and when the dog gets up to try to move away from the abuse, the adults call him back and make him lie down for more child torture. Meanwhile the child has lost interest and walked away and the parents insist that he come back and interact with the dog more.

This time the dog is lying on his side, and for the remainder of the two-minute clip the child climbs on and violently bounces up and down on the dog’s ribcage; grabs his jowls, cheek, and nose; and puts his face directly in the dog’s face, all the while with encouragement and laughter from the parents. Through it all, the dog is giving off constant signs of stress and distress – whale eye, panting, tongue flicks, gasping for air, and more. (If you really want to see it, we made a shortcut to a copy of the original video that someone captioned with notes about the dog’s warning signs: tinyurl.com/WDJ-abuse.)

This should be prosecutable child endangerment as well as animal abuse. Someday, if the incredibly tolerant Rottweiler has finally had enough and bites the child, the parents will be aghast. “We don’t know what happened – he was always so good with little Bobby!” And if the defensive bite is serious enough, the dog is likely to lose his life as a result . Meanwhile, if the child tries this incredibly inappropriate behavior with a less tolerant dog (which would include most dogs on the planet), he’s likely to be very badly bitten, and again, the unfortunate dog might easily pay with his life. What were these parents thinking?

A commonly quoted statistic states that some 4.7 million dog bites occur in the U.S. annually, with 42% of the victims age 14 or under.

As staggering as though those numbers may be, and as sensational as the “Dog Mauls Toddler” headlines are, they are also somewhat misleading. A very large percentage of those millions of bites are relatively minor, so the situation isn’t nearly as dire as it first appears.

Still, even one preventable child-mauling incident is one too many, and many of them are, in fact, quite preventable.

Supervisor Needed

Supervision of interactions between dogs and children is, indeed, critically important, at least until it is crystal clear that the child and dog are safe together. The “You must supervise kids and dogs!” mantra has been repeated so many times I would be surprised if there’s even one parent in the Western world who hasn’t heard it.

But here’s the rub: A significant number of kids suffer from dog bites even when the parent or other caretaker is directly supervising the interaction. If “supervision” is the holy grail of dog-kid interactions, how does this happen?

It seems that, over the years, as we trainers and behaviorists have repeated “Supervise, supervise, supervise!” until we’re blue in the face, we have somehow neglected to do a thorough job of helping parents and caretakers understand exactly what they are looking for when they are supervising.

It’s not just about being present, it’s also about watching closely, preventing the child from interacting inappropriately with the dog, and watching the dog for body language signals that communicate some level of discomfort with the child’s presence and/or interactions.

Upper Level Management

Management – controlling your dog’s environment and access to unsafe or undesirable things or practices – is a vital part of any successful behavior and training program. With kids and dogs, it’s even more critical. When you aren’t able to actively supervise (no TV! no texting!), you must manage. The price for management failure is simply too high.

A DICTIONARY OF CANINE STRESS SIGNALS

  • Anorexia Stress causes the appetite to shut down. A dog who won’t eat moderate- to high-value treats may just be distracted or simply not hungry, but refusal to eat is a common indicator of stress. If your dog ordinarily likes treats, but won’t take them in the presence of children, she is telling you something very important: Kids stress her out!
  • Appeasement/Deference Signals Appeasement and deference aren’t always an indicator of stress. They are important everyday communication tools for keeping peace in social groups and are often presented in calm, stress-free interactions. They are offered in a social interaction to promote the tranquility of the group and the safety of the group’s members. When offered in conjunction with other behaviors, they can be an indicator of stress as well. Appeasement and deference signals include:
    • Lip Licking: Appeasing/deferent dog licks at the mouth of the more assertive/threatening/intimidating member of the social group.
    • Turning Head Away, Averting Eyes: Appeasing/deferent dog avoids eye contact, exposes neck.
    • Slow movement: Appeasing/deferent dog appears to be moving in slow-motion.
    • Sitting/Lying Down/Exposing Underside: Appeasing/deferent dog lowers body posture, exposing vulnerable parts.
  • Avoidance Dog turns away, shuts down, evades touch, and won’t take treats.
  • Barking In context, can be a “distance-increasing” stress signal – an attempt to make the stressor go away.
  • Brow Ridges Furrows or muscle ridges in the dog’s forehead and around the eyes.
  • Difficulty Learning Dogs (and other organisms) are unable to learn well or easily when under significant stress.
  • Digestive Disturbances Vomiting and diarrhea can be a sign of illness – or of stress; the digestive system reacts strongly to stress. Carsickness is often a stress reaction.
  • Displacement Behaviors These are behaviors performed in an effort to resolve an internal stress conflict for the dog. They may be performed in the actual presence of the stressor. They also may be observed in a dog who is stressed and in isolation – for example a dog left alone in an exam room in a veterinary hospital.
    • Blinking: Eyes blink at a faster-than normal rate
    • Nose-Licking: Dog’s tongue flicks out once or multiple times
    • Chattering Teeth
    • Scratching (as if the dog suddenly is very itchy)
    • Shaking off (as if wet, but dog is dry)
    • Yawning
  • Drooling May be an indication of stress – or response to the presence of food, an indication of a mouth injury, or digestive distress.
  • Excessive Grooming Dog may lick or chew paws, legs, flank, tail, and genital areas, even to the point of self-mutilation.
  • Hyperactivity Frantic behavior, pacing, sometimes misinterpreted as ignoring, “fooling around,” or “blowing off” owner.
  • Immune System Disorders Long-term stress weakens the immune system. Reduce dog’s overall stress to improve immune-related problems.
  • Lack of Attention/Focus The brain has difficulty processing information when stressed.
  • Leaning/Clinging The stressed dog seeks contact with human as reassurance.
  • Lowered Body Posture “Slinking,” acting “guilty” or “sneaky” (all misinterpretations of dog body language) can be indicators of stress.
  • Mouthing Willingness to use mouth on human skin – can be puppy exploration or adult poor manners, but can also be an expression of stress, ranging from gentle nibbling (flea biting) to hard taking of treats to painfully hard mouthing, snapping, or biting.
  • Obsessive-Compulsive Disorders These include compulsive imaginary fly-snapping behavior, light and shadow chasing, tail chasing, pica (eating non-food objects), flank-sucking, self-mutilation and more. While OCDs probably have a strong genetic component, the behavior itself is usually triggered by stress.
  • Panting Rapid shallow or heavy breathing – normal if the dog is warm or has been exercising, otherwise can be stress-related. Stress may be external (environment) or internal (pain, other medical issues).
  • Stretching To relax stress-related tension in muscles. May also occur as a non-stress behavior after sleeping or staying in one place for extended period.
  • Stiff Movement Tension can cause a noticeable stiffness in leg, body, and tail movements.
  • Sweaty Paws Damp footprints can be seen on floors, exam tables, rubber mats.
  • Trembling May be due to stress – or cold.
  • Whining High-pitched vocalization, irritating to most humans; an indication of stress. While some may interpret it as excitement, a dog who’s excited to the point of whining is also stressed.
  • Yawning Your dog may yawn because he’s tired – or as an appeasement signal or displacement behavior.
  • Whale Eye Dog rolls eyes, flashing the whites of his eyes.

Even if your dog adores children (and especially if she doesn’t!), management and supervision are vitally important elements of successful dog/baby/child-keeping. There are a staggering number of serious child-bite cases (and fatalities) where the adult left the room “just for a minute.”

That’s why dog training and behavior professionals are well-known for repeating the warning, “Never leave dogs and small children together unattended.” This means, not for a moment. Not while you take a quick bathroom break, or run to the kitchen to grab a snack. Even if the baby is sleeping! Take the dog with you if you leave the room where the baby is sleeping or the child is watching a video. Put the dog in her crate. Shut her in another room.

 Training

Of course, you want to do everything you can to help your dog love children. Even if you don’t have small humans of your own, your dog is likely to encounter them at some point in her life, and things will go better for all involved if she already thinks kids are wonderful.

Ideally, every dog should be well socialized with babies and children from puppyhood. Many young adults adopt a pup at a time when children are, if anything, a distant prospect, without thinking about the fact that kids could easily arrive within the 10 to 15 years of their dog’s lifespan. Even if there will never be children in the dog’s immediate family, chances are she will encounter small humans at some point in her life. By convincing her very early on that children are wonderful, you greatly reduce the risk that she will ever feel compelled to bite one.

If an adult-dog adoption is in the works and there will be (or are) children in your world, remember this critically important caveat: Dogs who are going to be around babies and/or children must adore kids, not just tolerate them. A dog who adores children will forgive many of the inappropriate things young humans will inevitably do to dogs, despite your best efforts at supervision and management. A dog who merely tolerates them will not.

Teach Your Children

Safe child-dog interactions start with teaching children – even very young children – how to respect and interact appropriately with dogs. If a child is too young to grasp the information, then the supervising adult must physically prevent the child from being inappropriate.

Babies and toddlers often flail their hands at new or exciting stimuli – like dogs. Not surprisingly, many dogs are likely to find this quite aversive! When young children are introduced to dogs, the adult needs to hold the child’s hand(s) and guide them in appropriately using their hands to touch the dog appropriately (gently and slowly) and without any flailing.

It’s equally important to teach children that dogs are not toys to be treated roughly. Even if your family dog tolerates – or even loves – being hugged, allowing your young child to hug your dog can prompt her to hug the next dog she meets – with possibly disastrous results. Until your child is old enough to understand that some things that are okay with your dog are not okay with other dogs, you are far safer not allowing her to do those things with your dog, either.

Ideally, engage your child to assist with your dog’s training at the earliest possible age using positive reinforcement-based methods that teach your child the importance of cooperation and respect, so your child learns how to interact appropriately with other sentient creatures. At the same time, you will be strengthening the positive association between your dog and your child.

Watch that Body Talk

Any time your dog shows any sign of being uncomfortable with your child’s presence, you must separate the dog and child to protect them both. Of course, in order to do this you must understand dog body language well enough to recognize when a dog is expressing discomfort.

People often say, “If my dog could only talk…” They actually do communicate! But their mode of communication is body language – and too few humans take the time to learn that language, or “listen” to what the dog is telling us.

Above, we shared  some different ways your dog may be telling you she’s uncomfortable. This is an extensive list, albeit not necessarily a complete one. Study it, and then watch your dog for any of these behaviors, both with children present and absent. Any time you observe stress signals from your dog in the presence of children (or elsewhere!) it’s wise to take immediate steps to reduce her stress.

If, while you’re managing, supervising, and training your dog around kids, you’re having trouble determining what your dog is trying to tell you with his body language communications, ask a force-free dog training professional to help you. It could save your dog’s life. And your child’s.

Confidence Lost

By
Nancy Kerns
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7

When Woody (my three-year-old pit bull-mix) was a tiny puppy, just another one in a litter of nine that I was fostering for my local shelter, he was always happy to receive medical attention (vaccines, deworming, and even neuter surgery!), as it came layered with happy attention from the shelter veterinary staff. He loves people, so it was all good.

Woody’s friendly, happy attitude about having a stranger greet and handle him in an intimate way survived all those visits, as well as many more visits to a regular veterinary hospital. Let’s see… there were at least one or two vaccine visits; one “dietary indiscretion” incident (he ate all the food I had set out for the 11 Great Dane foster puppies, after I had already fed him his dinner); the time he swallowed a friend’s dog’s mini-tennis ball; the staples he needed on his rear legs (slashed his wrists on something sharp in the grass, sliding for a ball); the time he tore a toenail (mostly) off; a foxtail visit or two; a weird bump on his face that required minor surgery to remove it… He’s been to the vet a lot! And until last year, he was always happy to trot into the hospital, hop onto the scale, be examined by anyone, and even go “into the back” for his staples or bandages or injection of “Let’s make you vomit!” medication.

And then he got sick with a gastrointestinal bug that left him seriously dehydrated, and I left him to be hospitalized overnight. I am certain they didn’t mistreat him in any way! But ever since I left him there that night, when I take him back to the vet now – most recently for a canine influenza vaccine – he is reluctant to enter the hospital, and he shivers and shakes in the waiting and exam rooms.

I’ve started trying to remediate this anxious response, stopping by the practice to just weigh him and feeding him tons of high-value treats in the minute or two that we are there. And, because scared and/or anxious dogs have the potential to bite, and I wouldn’t blame any veterinarian or veterinary staff member if they felt safer working on my big, muscular dog if he were wearing a muzzle, I also am going to start acclimating Woody to wearing one. I want it to be a familiar, reinforcing experience in case we ever need it, rather than an incredibly scary thing suddenly strapped to his face in a medical emergency.

But after working on the article in this issue about Fear Free veterinary practices (see page 6), I’m also going to encourage my vets to seek out Fear Free certification – and keep my eyes peeled for a Fear Free certified veterinary practice to switch to if need be. Because I think I am going to need a whole team of people to get Woody past his newfound apprehension about receiving medical care. And that is just no way to go through life – particularly if you are as accident-prone as my goofy Woody.

A Perfect New Home For My Foster Dog Odin

By
Nancy Kerns
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33
Odin with his new owner
Odin in his new home, with Adam (in red) and his neighbor friends. They all love playing with Odin, and vice versa. Odin sleeps in Adam's bed, too.

When, back in March, I scheduled a week-long vacation for early July, I of course had no way of knowing a huge, dog-related story was going to erupt the week before. I also didn’t know that a great home for my long-time foster dog was going to pop up out of the woodwork in the days before I left. Both events left me scrambling and off-balance.

In early July, someone had commented on a video of my foster pup, Odin, and my young dog, Woody, that I had posted on the WDJ Instagram account: “How has he not been adopted? He has home skills, is dog social, and couldn’t be more stinkin’ cute! Come on, people!” And I had responded, “I haven’t been trying THAT hard to promote him. Been super busy with life stuff. No actual adoption attempts are likely to happen in the whole month of July, for various reasons. In the meantime, I keep visualizing the world’s most perfect home for him. We will see.” And then, just a few days later, I received a message from a friend: “Are you still looking for a home for Odin?”

A Perfect Family

“Maybe,” I responded. I wanted him to find a home, but it had to be a perfect spot. Given his many months of having to suffer many daily applications of various eye medications, he hadn’t yet spent much time alone, and above all, I wouldn’t allow him to go to go a home where he might end up alone for many hours a day. I wanted him to live with a person or family who had lots of time for him, who liked to play and be active, who might take him somewhere that he could swim, and who would let him live indoors and sleep on the couch or beds.

The more I heard about the family that my friend knew, the more I thought that perhaps this was it – the best place for Odin. And yet, the very thought made me weepy. But I agreed to meet the family. They came to my house twice, once on Friday and again on Saturday, spent hours watching and playing with Odin, and telling me about their house and family. It seemed like a perfect fit. I sent them to the local shelter to fill out the adoption papers and pay the adoption fee. I was leaving town Sunday night, and they could come pick him up Sunday afternoon to take him home.

Odin kayaking on a lake
Odin went camping, and loved kayaking, and sleeping in the kids’ tent

It was perfect and awful, all at once. I told them I wanted to take a picture of the whole family with him before they left with him, but as we approached their car, I started crying and didn’t want to make them uncomfortable or embarrass myself. Odin jumped into their car happily, sitting on the back seat with their young son. I gave Odin a kiss on the nose and told him to be a good dog, and turned away quickly, calling over my shoulder, “Send me a picture when you get home!”

Time for a vacation

I had spent the days before I left town making sure that my house was clean and organized and ready for my house-sitter/pet-sitter, and that I had all the Kong toys I own rounded up, clean, filled with canned food, and in the freezer. That morning, I had also rounded up Odin’s favorite toys and chewies and bed to send home with his new owners, but I hadn’t yet packed MY suitcase for my trip (I think this is a common dog owner thing). Fortunately, that kept me busy, and not crying much, all the way until the sitter, one of my son’s friends (and a young man I have known for 23 of his 27 years) arrived at my house for a briefing about Otto and Woody and the house. And by the time we finished with all that, it was time to head for the airport.

By the time we were at our connecting airport, my phone had received a number of photos of Odin and his new best friend, the young son in the family with three kids, at their home. He and the young son both looked perfectly happy.

Our vacation had officially started, but I was not yet done with work I promised to do before I left town. I had also spent the previous week talking to people I know and respect about the most recent update from the United State’s Food and Drug Administration (FDA) concerning the connection between diet and cases of canine dilated cardiomyopathy (DCM). I had started writing a blog post that contained my own thoughts about the update, and I had written pages and pages, deleted pages and pages, and wrote even more. But I kept changing what I felt was most important to say about it. As each day passed since the FDA update was published, more analysis was published – some that I found very good and insightful and some that I found to be hysterical and inaccurate.

The FDA Update Is Still On My Mind

I finished the post on the second leg of our flight, and sent it to our publishing HQ to be posted on the WDJ blog site. And then I tried to turn off my brain – I didn’t want to think about saying goodbye to my little Odin, or the news about the DCM investigation, or my dogs left at home. My husband, my son, and I spent five days at my sister’s house in a tiny town in the Colorado mountains, hiking some high peaks. Then we drove back to Denver, where my son competed in a tournament for his sport, and where we met our 7-year-old grandson and his mom, and spent a day with them before taking the boy back to California to hang out with us for a few weeks.

Hiking path in Colorado
We hiked in places like this in Colorado for days – bliss.

But the FDA update and the news coverage of it was explosive, and as much fun as I had on vacation, I couldn’t help but peek at the news and comments on my blog post a few times. The issue is complex and analysis of the information in the FDA’s update is varied. People are still confused and upset – and it doesn’t help that the owner of practically every dog who is sick or has died in the past two years thinks it is probably due to the fact that the dog ate grain-free food at some point, and posts this as fact on social media. No matter that the dog had eaten a grain-free product for a matter of days, or had a health problem that had absolutely nothing to do with the dog’s heart.

I will be writing more about the DCM issue, and also posting links to voices/sources that I respect (such as this one). I am completely sympathetic with those who have lost pets to DCM and possibly related causes, and also concerned that so much misinformation and hysteria is being shared.

Update on grain-free diets and DCM cases in dogs

By
Nancy Kerns
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137
FDA table on ingredients in dog food

On June 27, 2019, the United States Food and Drug Administration (FDA) released an update to two previous advisories regarding dog food and dogs who had developed dilated cardiomyopathy (DCM).  The release made a splash in the mainstream news – but this is all that most people seemed to get out of the news coverage: “THERE ARE 16 BRANDS OF DOG FOOD THAT ARE KILLING DOGS!”

Unfortunately, this is a wildly oversimplified take-away message. It set off a panic in the countless dog owners who feed their dogs some variety made by one of those companies, and may have inflicted serious financial damage to the companies named (as well as all the retailers who sell them) – this, despite the fact that the FDA stated at the outset of the release that the cause of the DCM cases is still unknown. “Based on the data collected and analyzed thus far, the agency believes that the potential association between diet and DCM in dogs is a complex scientific issue that may involve multiple factors.”

Further, in a “Questions and Answers” addition to the update, the agency says things like, “At this time, we are not advising dietary changes based solely on the information we have gathered so far,” and “It’s important to note that the reports include dogs that have eaten grain-free and grain-containing foods and also include vegetarian or vegan formulations. They also include all forms of diets: kibble, canned, raw and home-cooked. Therefore, we do not think these cases can be explained simply by whether or not they contain grains, or by brand or manufacturer.”

It’s a bit puzzling, then, why the agency named the brands of foods that were reportedly fed to some of the 560 dogs whose DCM cases they are investigating (and even more puzzling: why they didn’t include the varieties of foods that were implicated, just the company names). Naming the companies suggests that those companies were responsible for the dogs’ illnesses, even as the agency denied this as an explicit causation. We’re not usually conspiracy theorists, but this move undoubtedly gave a boost to these companies’ competitors.

We don’t mean to sound protective of the companies. Don’t get us wrong: If it can be proven that a company has knowingly or even inadvertently (through cost-saving measures, say) taken steps that resulted in a previously known or predictable harm to dogs, we’d be happy to help drum them out of business. The point is, the cause of these cases is STILL unknown. So why name the companies, rather than just describe the characteristics of the products that have been implicated so far?

Our guess is that so many people buy and feed products without having a clear reason for doing so, and so many fail to read the ingredients panel and guaranteed analysis – perhaps naming companies was the only way to get owners’ attention, and to alert them to check their foods, and think about their dogs’ condition. If they are feeding a product from one of the named companies, are their dogs displaying any symptoms of compromised cardiac health?

The only explicit advice that the FDA offered to owners wanting to protect their pets came at the end of the update: “If a dog is showing possible signs of DCM or other heart conditions, including decreased energy, cough, difficulty breathing and episodes of collapse, you should contact your veterinarian as soon as possible. If the symptoms are severe and your veterinarian is not available, you may need to seek emergency veterinary care.” This is sound advice – and owners would do well to follow it regardless of what diet their dogs are fed.

Information about the cases

We do believe that the agency is more concerned about protecting our health and that of our pets than protecting industry interests, though, again, naming some (not all!) of the companies was kind of a weird move. However, we very much appreciate the fact that, in an effort to give pet owners and industry insiders more information about the issue, the agency has shared much more information in this update and other linked documents than was previously released.

Between January 1, 2014 and April 30, 2019, the FDA received 524 reports of DCM; this includes some 560 dogs and 14 cats. Some of the reports include cases in which multiple pets in the same household developed DCM – which is why total affected animals (574) add up to more than the number of reports (524). The cat cases are beyond WDJ’s area of expertise and we will not discuss these.

The agency also has received many reports regarding dogs with other cardiac problems, but if a dog was not diagnosed with DCM by a veterinarian or veterinary cardiologist, his or her case was not counted in the totals above. The FDA says it will continue to collect information about these cases, as dogs may exhibit cardiac changes before they develop symptomatic DCM. For more about these changes, see “Non-DCM Cardiac Cases” in this linked addendum to the June 27 update.

Some of the detail included in the update dramatically helps illustrate the immediacy of the issue. Though earlier reports referred to DCM cases dating back to 2014, we learned from this update that there were only seven reports regarding DCM made to the FDA from 2014 through 2017: one in 2014, one in 2015, two in 2016, and three in 2017.

But in 2018, the FDA received a communication from a group veterinary cardiology practice in the northeast concerning an unusual cluster of cases of DCM. The veterinarians reported that they had seen a number of dogs with DCM who were 1) not breeds known to be at a higher inherited risk of DCM, and 2) most had been eating grain-free diets prior to diagnosis.

Veterinary cardiologists discussed this with colleagues. Soon, other practitioners realized that they, too, had seen more cases of DCM in dogs of atypical breeds for the condition – and many of them, too, were eating diets that were grain-free and/or high in legumes and/or potatoes. More and more veterinarians started submitting reports about their patients to the FDA.

The FDA released its first advisory about this issue in July 2018, in order to alert pet owners and general-practice veterinarians of the possibility for DCM to develop in dogs, especially if they had been maintained on grain-free/legume-rich diets for any significant period of time. The agency warned interested parties to be on the lookout for the symptoms of DCM: loss of appetite, pale gums, increased heart rate, coughing, difficulty breathing, periods of weakness, and fainting.

This news almost immediately triggered a spike of cases being reported to the FDA. Some 320 reports of DCM were made in 2018; so far in 2019 (through April 30, the most recent date included in the FDA advisory update), some 197 reports of DCM have been made. Of the 560 dogs discussed in these reports, 119 have died.

The FDA cannot confirm, however, whether these numbers indicate an actual increase in the population of dogs that develop or die from DCM or whether the attention brought to bear on this issue has increased awareness and hence reporting; unlike in human epidemiology, rates of disease and deaths are not kept for animals. (FDA: “Because the occurrence of different diseases in dogs and cats is not routinely tracked and there is no widespread surveillance system like the Centers for Disease Control and Prevention have for human health, we do not have a measure of the typical rate of occurrence of disease apart from what is reported to the FDA.”) Because we don’t know what the rate of DCM is overall, it’s possible that many cardiac problems, diet-related or not, have gone unreported or even undetected (for example, mistakenly attributed to “old age”) until the FDA advisories and updates brought it to the attention of many dog owners.

One of the major points made in the 2018 advisory was that cardiologists were seeing the unexpected development of DCM in atypical breeds and in dogs with other atypical characteristics. DCM tends to affect dogs of certain breeds (most of which are large and giant breeds), older dogs, and more dogs who are overweight than of ideal or low weight. Veterinary cardiologists say they are seeing more cases in breeds that are not known to have a genetic predisposition to DCM, in younger dogs, and in medium and even very small dogs.

The FDA’s 2019 update confirmed that there has been, at a minimum, a shift in the makeup of the dogs involved in these 560 cases. The update contains a table that enumerates how many dogs of various breeds are represented in the 560 cases. The breed with the most cases (95) is the Golden Retriever. However, according to registration numbers of purebred dogs, it’s the third most popular breed in the U.S. Also, the FDA has speculated that there has been greater awareness and social media discussion about DCM among Golden Retriever owners (as they are prone to a taurine-responsive form of DCM), and this perhaps prompted Golden owners to bring their dogs to the vet and be diagnosed sooner, and to report their cases to the FDA.

Mixed-breed dogs are next on the list with 62 cases, then Labrador Retrievers with 47; in neither case would those dogs be expected to have a genetic predisposition to DCM. There are more mixed-breed dogs in the U.S. than any individual pure breed, and Labradors are the most numerous purebred dog in the U.S., so it may be that these dogs are represented so high on this list by virtue of their greater representation in the population. Fourth on the list, though, is a breed that is known to have a genetically higher risk of DCM: Great Danes, with 25 cases. There were 23 pit bulls, and then two more breeds known to be at higher risk of DCM: German Shepherd Dogs (with 19 cases) and Doberman Pinschers (15).

DCM tends to affect more male dogs than females, and that pattern has held, with 58.7% of the cases involving males. This, as well as the atypical age and breed distribution of the cases, had led FDA researchers to surmise that the cases that have been reported to them this far are the result of a combination of expected causes (inherited predisposition) and dietary causes.

The implicated companies

Again, it’s a little weird that the FDA named pet food companies, when the link between the foods and the cases of DCM is not yet clear. Even stranger is that they named only 16 companies – that fact seemed to make the biggest impression on the mainstream media. Headlines in publication after publication make it sound like there are just 16 companies that have been doing something wrong –making it sound as if as long as you avoid those companies when buying your dog’s food, all will be well. If only!

The 16 companies named by the FDA appear on a table presented in the update (linked again here, scroll down). The table lists the 16 companies that were named in 10 or more of the cases of canine DCM reported to the FDA since 2014. These 16 were implicated in 431 of the cases; the foods that were fed to the pets in the other 129 of the cases were not in the table – which leaves open the possibility that someone feeding a food that caused, say, nine cases, remains unaware that their dog’s food, too, may potentially contribute to their dog developing DCM. It’s a tad random.

The companies mentioned in every single one of the 560 cases are available, but not in a particularly accessible way. A link provided in the update takes the reader to a 77-page table that lists all known information about each DCM case presented to the FDA. We plan to mine that 77-page table for all this information – the companies named in fewer than 10 cases, as well as the varieties mentioned in every case – in the weeks ahead. We will share it with you when we’re done – or share a link if someone does this and posts the information before us.

Also, the update did not specify which varieties of each company’s products were implicated. While some of the companies named make only the type of products that have been implicated in the majority of reports (we will get to that in a minute), some of those 16 companies make two types of products: the type that has been implicated in the vast majority of the 560 cases, as well as products that contain grain and do not contain any of the ingredients that seem to be associated with the development of DCM. In the case of these companies, naming only the brand and not the varieties implicated in the reports was a disservice to the companies and consumers alike.

Characteristics of the implicated foods

The FDA has not yet reached any conclusions about definitive links between the foods that the 560 dogs were being fed and their development of DCM. However, if, in an abundance of caution, an owner wanted to avoid products that share the traits of these foods, it’s possible to do so. The update includes enough information about the implicated foods that could help consumers select foods that do not share the traits of the implicated foods. Just keep in mind that causation is still unknown and that the FDA’s only conclusion so far is that “DCM in dogs is a complex scientific issue that may involve multiple factors.”

The vast majority of the products that the owners were feeding to the dogs in the reports submitted to the FDA were dry dog foods: 452 of the 515 reports involved dry dog food. The thing is, 452/515 is 88%. Currently about 85 to 90 percent of owners feed dry food, so this proportion is probably equal to the proportion of healthy dogs who are fed dry diets, so (statistically speaking) is meaningless information.

Grain-free diets represented 91% of the products implicated in the reports; 93% contained peas and/or lentils. Potatoes and/or sweet potatoes were present in 42% of the products. These numbers are far more intriguing.

The inclusion of peas, lentils, chickpeas, and other legume seeds have reached some sort of critical mass in recent years with pet food manufacturers. Though they’ve been present in many pet foods for at least a decade, in recent years, the percentage of their representation in formulas has grown. We wouldn’t worry unduly about one of these ingredients appearing on an ingredients panel in a minor role – 6th or 7th or lower on the list, say. But if there is more than one of these ingredients on the list and/or one in one of the top five or so positions on the ingredients list, for now, we’d look for another product to feed our dogs.

There are a number of animal nutrition experts speculating about what might be happening with these foods and why some dogs who have been eating them have developed heart problems. We will follow up with some analysis of some of the leading theories in future posts, but for now, let’s focus on what owners can do immediately to protect their dogs, based on what is currently understood and/or suspected about the relationship between the foods named in the reports made to the FDA and the dogs’ health problems.

Our recommendations for action

1. As we stated in our response to the 2018 advisory a year ago, no matter what your dog eats, if she has any signs of DCM – including decreased energy, cough, difficulty breathing, and episodes of collapse – you should make an appointment to see your veterinarian ASAP, preferably one who can refer you to a veterinary cardiologist.

2. For now, we would strongly recommend avoiding foods that use peas – including constituent parts of peas, such as pea starch, pea protein, and pea fiber, and especially multiple iterations of peas (such as green peas, yellow peas, pea protein, etc.) as major ingredients. If any one of these appears higher than the 6th or 7th ingredient on an ingredient list, for now, we’d switch to foods that do not display this trait.

Same goes for chickpeas (may be referred to as garbanzo beans), any other type of bean, and lentils.

We’d switch away from any foods containing more than one of these ingredients (peas, beans, or lentils).

3. Also, if you read through the 77-page table that includes every one of the 515 reports received by the FDA about a pet with DCM, you will see many times over that pet owners fed whatever they had been feeding to their dogs for months or even years. The same food, day in and day out. Month in and month out. Year in and year out! We’ve said it before and we will say it again: Feeding the same food for months on end amounts to putting your dog’s life in a single company’s hands. Is there any company on earth that you would trust to provide ALL the nutrition you consume for the rest of your life?

Please switch foods frequently, and not just from one variety to a different variety made by the same company. Switch among products that are made by different companies, with different ingredients. Unless your dog has a proven allergy to a number of ingredients, switching from one food to another, as often as every time you buy a new bag of food, helps provide your dog with “balance over time,” and keeps any nutritional imbalances, overages, or deficiencies from contributing to your dog’s health problems.

4. As we have stated many times, we would feed grain-free foods ONLY to dogs with a demonstrated allergy to or intolerance of grains.

When grain-free dry dog foods were first introduced to the market, we were happy that owners of dogs who had a proven intolerance of or allergy to one or more grains could find commercial dry food options. However, as this segment of the market exploded, it became apparent that many more owners were choosing these products than dogs needed them. Somehow, the message spread among dog owners that grain-free foods were “better” – with little or no explanation offered as to why this was alleged. We based our concern about their over-popularity on the high levels of inclusion of ingredients that did not have a long history of use in dry dog foods. Potatoes and sweet potatoes worry us less than peas, chickpeas, and beans; they have been utilized in dry dog formulas for longer than the legumes.

What if your dog absolutely can’t consume ANY grain (and this has been demonstrated with a sound food allergy trial)? There are a number of companies whose grain-free foods do not appear or appear very infrequently on the 77-page table of all the DCM reports. We are aware that some dog food manufacturers add supplemental taurine to their products (and have always done so). Whether this or some other factor (ingredient sourcing, better manufacturing, better formulation, etc.) is responsible for their scarcity on that list, no one knows for sure. But if your dog absolutely can’t consume ANY grain, we’d look for products without peas or legumes (or those with perhaps ONE of these ingredients low on the ingredients list), from a manufacturer whose name is not found on the table… and to hedge your bet, we’d check to see whether they add supplemental taurine to their formulas (and go with one of their products if they do).

Not all of the dogs in these reports have been found to exhibit low taurine levels – and none of the diets implicated in the reports have been found to contain levels of the amino acids that dogs use to manufacture the taurine they need (cysteine and methionine) that fail to meet the current levels legally required for a “complete and balanced diet.” However, there are several compelling possible reasons that could result in the dogs’ failure to utilize or benefit from these amino acids. For example, some chicken meals are so low in digestibility – and often so heat-damaged – that the methionine is not present in an available form. Also, high fiber levels can interfere with some dogs’ ability to convert these amino acids into the amount of taurine they need. The main point is, there are dogs who have shown improvement after their diets have changed and supplemental taurine was prescribed.

Note: The possibility has been raised that there may be more than one mechanism at work causing all these DCM cases and cases of other cardiac problems, something to do with the cysteine /methionine/taurine issue and something else. While the vast majority of the implicated diets mentioned in the FDA’s reports are dry, grain-free foods, some food that do contain grains also have been implicated, as well as some canned, raw, etc. diets. All owners need to be alert to their dogs’ symptoms – and don’t just chalk up exercise intolerance, panting, lethargy, etc. to “old age” in previously healthy senior dogs! Make an appointment and discuss these symptoms with your veterinarian soon.

Skunks and Fireworks Are NOT a Dog’s Best Friends

By
Nancy Kerns
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26
Ready for several more skunks, if need be.

My senior dog Otto has never liked fireworks, but he’s never been a total wreck around the Independence Day holiday, either. He will pant a little bit and pace at the height of fireworks and firecracker activity, but will still eat and allow himself to be comforted.

This year was different. He’s aging, and seems to be getting increasingly neurotic and anxious about a few things. If anyone is doing laundry at my office/house, for example, he acts like most thunder-phobic dogs do in a thunderstorm. I think he can feel the shaking or vibration in the old wood-framed house, and he paces and shakes and pants, and won’t take treats. I used to be able to just stop the laundry and he would calm down. In the past year or so, he’s gotten so increasingly anxious about the possibility that there might be laundry, that I basically just don’t take him there very often anymore. He’s happier at home.

Except for this holiday. There is a casino less than a mile from where we live – as the crow flies, not on our road. And apparently, this year, the management opened up the parking lots to anyone who wanted to set off fireworks and it seems like half the county took them up on it. I got home from my office/house well before dusk and Otto was a nervous wreck.

Where my sister and her husband live, several miles out of town, there is a strict prohibition on fireworks; it’s also a high fire danger area. I didn’t hesitate to take Otto to her house to spend the night. He is happy and comfortable there, and we couldn’t hear a single snap, crackle, or pop.

Back at my house, neither Woody nor Odin minded what sounded like a war going on outside.

The next morning, I went back to my sister’s house to collect Otto. I walked into her living room, and hit a WALL of skunk scent. “I’m so sorry!” my sister said. “Otto went out the dog door at about 4 am and got skunked in the back yard!”

I was the sorry one! Their house REEKED! I guess since they had been smelling it since 4 am, they had gotten accustomed to it. I felt terrible, until my sister asked me, “Hey, would you help me look at Dinah’s butt? She keeps licking it.”

Dinah got fat!

Dinah is one of my former foster dogs. She was an anxious mama who came into my local shelter with one fat pup, and she thought it was her job to protect that pup from anyone who looked in their direction. At my shelter, that’s a death wish; nursing moms don’t get a pass just because they are mothers. If they are judged to be “aggressive,” they aren’t going to make it to the adoption row, so I had taken her and her puppy to my home to foster, about four years ago. The puppy got adopted by an acquaintance and my sister fell for Dinah. She is absolutely not aggressive, but super shy; when my sister and her husband have guests, she spends most of the time hiding under furniture. Most of their guests don’t even know she exists!

From Pam’s description, I was certain Dinah needed, at a minimum, to have her anal glands expressed, and perhaps a trip to the vet if one of the glands was infected or impacted. I pulled Dinah out from one of her hidey holes, and my sister helped me get her dressed in a harness. I said I would take care of Dinah, as my sister had to go to work.

Our first stop was at my house, to leave stinky Otto there. Then we went to Walgreens, to get every quart of hydrogen peroxide they had on the shelf, for de-skunking Otto. Next, we stopped at a local groomer; Dinah’s nails were super long and overdue for a trim. The groomer restrained Dinah enough for me to get a good look at her bottom. Sure enough, she has a sore next to the anus; she needs to go see a vet. I called the local clinic; they had no openings today, but could see her tomorrow morning. OK, I made that appointment. But is it an emergency? Should I take her to the emergency clinic in the next town?

Since I was close to the shelter, I decided to consult my friend, the veterinary technician there. She was busy with something, so I waited in the lobby for a few minutes, saying hello to my friends who are the front desk clerks there. It wasn’t even 10 am and one of them mouthed to me, “I want to go home!”

“Lots of lost dogs?” I asked, and they grimly nodded. But as one of them helped one gentleman at the front desk, when he was asked, “When did you last see your dog?” he answered, “Four days ago.” Yikes. I know I don’t have what it takes to be a receptionist at a shelter – a poker face? nerves of steel? – that’s for sure.

My friend took a peek at Dinah’s nether end and agreed that it could likely wait until tomorrow for an in-depth exam. She suggested we don’t feed her in the morning, in the likely event that she has to be sedated.

My sister just had a whopping vet bill when her other little dog got stomped by a deer in the empty lot next to her house. I feel bad that they have another bill on the way, but when it rains, it pours.

Dinah and I came home to give Otto another skunk bath – actually, his second in two weeks! When he was young, he got skunked twice in one week, and forever after, when we saw skunks, he would back away from them, licking his lips anxiously. I rejoiced and bragged that he was the only dog I knew who had “learned his lesson about skunks.” Well, all bets are off with senior dogs, from fireworks to skunks.

Next year, I think we will all go camping somewhere very remote.

I hope you had a nice holiday.

Here’s Why We Can’t Just Keep Every Foster Dog

By
Nancy Kerns
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43
puppies suffering from mange
Shortly after his litter's rescue and first treatment for demodectic mange (Odin is in back right corner)

“Why don’t you just keep him?”

Everyone who fosters dogs for a shelter or rescue group has heard some version of this, probably every single time they foster:

“That puppy is so happy with you! And he gets along with your dogs so well! You should keep him!”

“I can’t believe the transformation! He looks so gorgeous now, and is so well behaved! You should keep him!”

And the clincher: “That dog loves you so much! You should keep him!”

Why we can’t just keep them all

Here’s the thing: We who foster know that our foster dogs look better, feel better, are happier and healthier, and are better behaved than they were when we got them; that’s why we foster. And we are acutely aware of how much our fosters seem to love us. We, sometimes quite painfully, love them, too. But for most of us, if we keep our foster dogs, it means we can’t foster any more. So the next time for the next few years that our local shelter or rescue group calls, looking for a foster provider for another very needy but worthy dog or litter of starving puppies, we have to say, “Sorry, I can’t.”

“But what is just one more?” our friends ask. Well, when it comes to just one more mouth to feed, truthfully, it’s not that much. But every dog owner should be aware that the price of feeding a dog is just the tip of the iceberg of a dog’s total costs.

Veterinary and insurance costs add up quickly

Veterinary costs, especially for any emergencies, can completely sink a household budget. I’m a strong believer in pet health insurance, and it has saved me thousands – but there is the matter of the monthly payment and an annual deductible. As an example, I’m currently paying $60.05 a month for 3-year-old Woody’s insurance ($720.60 for the year), and $147.38 a month for 11-year-old Otto’s insurance ($1,768.56 for the year). Both have a $250 annual deductible; I pay the first $250 of veterinary expenses each year, and then the health insurance reimburses me for 90% of the rest of that year’s veterinary bills. So, my cost each year, before I qualify for any reimbursements, is $2,989.16. The cost for one more young dog’s health insurance would be at least the cost of Woody’s: $970 before the insurance would reimburse me a penny.

young puppy sitting on blanket
Such a good boy, on our first trip to the ophthalmology dept at UC Davis Veterinary Medical Teaching Hospital in December

Does that sound like a fortune? Well, it is. But it’s a monthly bill I can budget for – whereas a $6,000 bill for emergency surgery or a $10,000 bill for cancer treatments would be quite a blow. One can gamble with these things, but it’s just that, a gamble. And I don’t like gambling when my financial stability and emotional health are riding on the outcome.

Don’t forget about boarding or pet sitter costs

Then there is the cost of care if and when I travel. If I needed to board my dogs, the difference between boarding two and three is significant. My local boarding options charge anywhere from $45 a day per dog for a jail-like kennel and no extras, up to about $75 a day per dog for a nice facility that takes the dogs out several times a day. So one more dog would add $315 (for the jail) to $525 for a week of boarding.

Truthfully, I haven’t ever boarded my dogs or used a professional pet sitter (another option). I rely on friends and family for help taking care of my dogs when I travel – and in return, they can count on me to help them when they need it. Providing care for extra dogs can be time-consuming when time is at a premium, but it’s the deal we make with each other to ensure that our dogs are as safe and as secure as possible, with people they know and love, when we need to travel, whether for work or family emergencies or, every once in a blue moon, an actual vacation!

When my husband and I leave town, my senior dog Otto always goes to stay with my sister and her husband; he loves being the big dog in her pack of little dogs, and the plush life they enjoy. (On his first stay with them, he staked out the queen-sized bed in their spare bedroom as his preferred sleeping spot, even though he had access to lovely sofas and heaps of dog beds. No other dog gets that privilege! But his “Aunt” and “Uncle” love him and allow it, and I love them for it, even though he’s not allowed on my beds at home!)

I generally leave Woody at my office/house, and my tenant there feeds him and lets him outside. (I actually provide food and other supplies for his dog, so that’s a favor my tenant owes me.) Another friend, who walks dogs with me a lot and knows all about Woody’s training and proclivities and the trails where it’s safe to go, will stop by and pick up Woody to take on walks with her dog; so I owe Jessie some favors after she helps keep Woody happy when I’m gone.

It takes a village

Since I took on the ask of fostering my current foster pup Odin and his siblings back in November, I have had to call in even more favors for Odin’s care than for my own two dogs. An eye condition meant Odin needed eye medication many times daily for months and months, so when I traveled, the management and logging of all of those eyedrops fell to my friend Leonora – the one person I knew who was comfortable with administering eye medication and able to do it as many times as required.

two dogs cuddling together on couch
Sleeping with “Uncle Woody” in March

Ultimately, all of our efforts failed, and Odin’s eye was finally surgically removed, but he still requires more consideration when I leave town than my own dogs do. Odin is still very much in the adolescent “Fail to give me enough stimulation and I will chew anything I please” stage, so, in the past few months when I have traveled, I have had to call in yet more favors to keep him out of trouble. Leonora picks him up from my office/house on her way home from work, and he plays and sleeps with her dogs at night and on the weekend. He has shown that he can’t quite be trusted not to chew up stuff if left at her house during the day, but he’s perfectly happy and mostly nondestructive if he hangs out with Woody at my office, so my friend drops him there on her way to work each morning. That’s a LOT of favors I owe her after each trip.

Like me, Leonora loves and enjoys Odin, too. But she also has two dogs and two pet health insurance bills each month, and her older dog needs costly medication each month. She also pays for a pet-sitter to come to her house each day to let the older dog (especially) have a mid-day potty break. She would love to adopt Odin, but, like me, is concerned about the cost of adding another dog to her household.

Foster-failure trouble

I can usually easily dismiss the “You should keep him!” comments I get from family and friends and the people I am trying to promote my foster dogs to. I know they are well-meaning, and that, sentiment aside, most people understand that the commitment of a pet can’t be taken on that lightly. But a discussion I had last night with an acquaintance who is having a very hard time with two sibling foster-failures made me decide to just put this little tirade out there, anyway.

This woman is retired, and has two elderly dogs with complicated medical needs; both are former foster dogs who needed so much care that she ended up keeping them. Recently she fostered a mama dog and her puppies for a local rescue. The mama dog and the other puppies got adopted, but she just fell in love with the last two puppies, and they seemed to play so well together that she thought, well, they can keep each other company.

Healthy and ready for his new home

But now that they are in adolescence, they are starting to aggravate each other, and are also bothering her older dogs. She has sought out help from a professional trainer, but still feels overwhelmed. My friend is both kicking herself about making the decision to adopt them, and feeling desperate and heartbroken at the idea of re-homing one or both. She is in actual, physical pain at the idea of letting one or both of these pups go – and I totally get it. When I just think about saying goodbye to Odin – when I find the perfect home for him – I start to cry. I think back to what he looked like in November: a scabby, hairless, skeleton. How could I forget our many trips to UC Davis, trying to save his eye, and the many vets and vet students he charmed and delighted there. I am going to miss his habit of burying his head in my chest and leaning in for long, sweet hugs. 

Finding a forever home that’s just right

My acquaintance and I both know that these dogs can be happy elsewhere. And I think that we both know that they should live elsewhere. I can’t speak any more for her, but I know that I will be supremely happy when I can find a home for Odin where he will get more individual attention and love than he can get with me. It hasn’t happened in the past few weeks because I am being crazy-picky about who is going to get him. I want to make sure he ends up in a home with people who truly have time and space and a budget for a dog, and who will be just as touched by his cuddling and amused by his zoomies and appreciative of his gentle friendliness toward all humans as I have been.

When that happens, and I am certain he’s in the right place, and my heart recovers – then I can foster again, and try to help another little starving, mangey, and/or frightened dog or puppy get healthy and find a home. When I own just two dogs, I can afford that. But owning three dogs, in terms of time and money, puts me just over the line of what I can afford and take on responsibly. And I would like to keep giving back to more dogs, if I can.

If you’ve read this far, you probably aren’t the kind of person who will tell your friend who fosters, “You should keep him!” But if you are the kind of person who fosters, feel free to share this with your friends, so they can understand a bit more about what likely crosses your mind when they say that.

 

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By
Nancy Kerns
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Keep Your Dog Safe from Accidents

By
Nancy Kerns
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34
small dog with suture
Daisy after surgery

In a 48-hour period last weekend, three dogs who are very close to me ended up in veterinary emergency rooms. It was a very weird aggregation of events – but each event was avoidable, and each dog’s owner has taken responsibility for their dog’s potentially deadly accident.

Beware of Wild Animals Around Your Property

The first accident happened to Daisy, my sister’s little 15-pound Jack Russell Terrier. My sister and her husband live in a rural area, where most of the homes are on lots of a half-acre or more. In addition, they live at the bottom of a steep hill, on a court with just five houses on it, and several empty lots. She sometimes allows her little dogs to potty in the empty half-acre lot next door to her house. The lot is, like her own backyard, studded with oak trees, but unlike her yard, is covered with tall grass, and the little dogs enjoy sniffing and exploring the area as they take their potty break.

On this particular day, though, what my sister failed to notice as she let the dogs wander into the lot, was a female deer apparently lounging at the back of the lot. She didn’t see the moment that two of her dogs discovered the deer – or whether the deer spotted the dogs before they spotted her. But she heard one of her dogs shrieking and as she ran in the direction of the screams, saw a large female deer rearing up and stomping down on one of her little dogs.

Like many of us, she was focused on getting to and protecting her dog, and failed to appreciate the danger to herself as she ran toward the deer. She said she was yelling, “Hey! Hey!” and about 15 feet from the deer, fully expecting the deer to spook and run from her, when it, instead, reared up and charged at HER. She screamed and waved her arms and dodged behind a tree, and fortunately, little Daisy took that opportunity to bolt away from the deer. My sister, too, turned and ran and, again, fortunately, the deer didn’t pursue either of them. I suspect that she had a baby resting nearby or some other reason to go on the offensive. My sister didn’t investigate further, as Daisy was still screaming – now in pain, rather than from fear. The deer’s hooves had made one very deep and long laceration along Daisy’s flank, and her face was bleeding, too.

A night in the ER, x-rays, pre-anesthetic bloodwork, surgery (under anesthesia) to close the laceration and insert a drain, antibiotics, and pain medication: $1,600. Nope, they don’t have pet insurance.

Don’t Leave Out Food Leftovers or Dirty Dishes

pieces of tennis ball and glass from dog's stomach
Pieces of glass and tennis ball, retrieved from Nova’s tummy

The very next morning, I received a call from a friend regarding her dog Nova, who was my favorite puppy from a litter I fostered last fall. (I used her and Nova to model for an article in WDJ not long ago, you can see them here.) She said, “I just need a little support. I am at the ER with Nova and scared!” It seems she had made barbequed ribs the night before, and had left the glass pan, covered with baked-on sauce, on the stove top, to deal with the next day. In the middle of the night, Nova had apparently knocked the pan onto the kitchen floor, where it shattered into hundreds of pieces – and she spent some time licking the sauce off of those pieces of glass! There was broken glass  – and blood – all over the kitchen floor. My friend didn’t hesitate; she just put Nova into the car and drove straight to the emergency clinic.

panting dog
Nova: A little loopy, but no worse for wear after licking and ingesting broken glass, and having it retrieved from her stomach under anesthesia

The attending veterinarian used an endoscope (under full anesthesia) to examine Nova’s esophagus and stomach, and removed several pieces of glass – as well as several pieces of chewed-up tennis ball. She was incredibly lucky; the procedure took place quickly enough that Nova hadn’t yet vomited (which could have made the glass cause damage on the way out of the stomach and in Nova’s throat), nor had the glass hadn’t started to move through Nova’s intestines. The blood that her owner saw on the kitchen floor was definitely caused by cuts the glass made on Nova’s tongue, but none of those cuts (nor others in her esophagus) were serious enough to require surgical repair.

Total cost: $2100. Fortunately, Nova’s owner has pet health insurance. Since she had another vet visit earlier this year and has already spent the $250 deductible for 2019, she will receive a reimbursement from the insurance company for 90 percent of the most recent bill.

Nova’s owner reports: “I have learned my lesson; my counters are the cleanest in the county and there won’t ever be a mistake made like this again. Also, no more tennis balls for Nova.”

Another Counter-Surfing Case

The same afternoon that my friend was picking up Nova after her procedure, I received a text from another friend! “Ricky ate Chaco’s pain meds. We are at (a local vet clinic).”

While ALL medications should be kept in kitchen or bathroom cabinets – never on counters that dogs can reach – this is especially true of chewable medications. Most dogs won’t eat more than one nasty-tasting pill they find lying around. But the chewable kind tempts many dogs into eating the whole bottle – and that’s what Ricky did. He ate about eight Deramaxx pills, a nonsteroidal anti-inflammatory (NSAID) that can cause liver damage if an overdose is consumed.

chewed-up medicine bottle
The medicine Ricky ate

Again, fortunately, my friend discovered the chewed-up, empty bottle right away, and drove immediately to a veterinary hospital, where they administered an injection of apomorphine, which makes dogs almost instantaneously vomit. So Ricky has (apparently) suffered no ill effects, and the bill was a quite reasonable $170 (no insurance).

We’re All Susceptible

Lest anyone think I am judging my friends: I, too, once had a dog eat a whole bottle of chewable medication meant for another dog (I wrote about that in 2013!). The experience made me VERY careful about where I put medications.

Protecting our dogs is an ongoing, complex task, and none of us can prevent every potentially fatal accident. But all of these were preventable – and my sister and friends  and I all hope that these stories make you just that much more alert and able to prevent any of these accidents from befalling your dogs!

In case you want to learn about more ways to avoid a trip to the veterinary ER, here is a link to an article that veterinarian Catherine Ashe (who practiced emergency veterinary medicine for nine years) wrote for us last year.

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